Abstract :
ISSUE: At this acute care facility, the responsibility of assigning patients to isolation, unless ordered by the physician, often became the responsibility of the infection control practitioner (ICP). As the ICP performs surveillance using data such as microbiology results or admitting diagnosis, there was a time lag for proper placement of patients for transmission-based precautions.
PROJECT: An infection transmission risk assessment (ITRA) tool was created on the nursing admission assessment form incorporating Centers for Disease Control and Prevention (CDC) Guidelines for Isolation Precautions in Hospitals. The infection prevention committee approved the ITRA tool. The medical executive team empowered nurses to isolate patients based upon this assessment or physician diagnosis. All nurses in orientation are introduced to the ITRA tool. During the annual nursing competency, recent cases are used to illustrate proper isolation category. Appendix A from the CDC isolation guidelines was made available for easy reference on specific diseases. A daily worksheet with isolation patients prints on each inpatient station to improve communication and accountability for isolation after an isolation task force identified this as an opportunity. The task force was a multidisciplinary team that met weekly or biweekly in 2003 to address communication and process problems related to isolation.
RESULTS: The ITRA tool became part of the nursing admission form in 2001. However, only 60% of patients were assessed for isolation in 2002. In 2004, 97.3% of patients were correctly isolated. Proper isolation codes in the computer system improved dramatically (0% in 2002 versus 94% in 2004). An increase in medical discrepancies for isolation errors occurred (51 in 2002, 78 in 2003, 102 in 2004), showing the heightened awareness about isolation needs.
LESSONS LEARNED: The ITRA tool by itself was not enough to improve isolation; it required frequent education and wide support. The task force identified and developed processes to reduce isolation problems and encouraged the environmental climate to effect change. The multidisciplinary team, not the tool, made the difference.
